REHABILITATION

REHABILITATION

Dr. Bailie believes in a team approach when it comes to treatment of orthopedic injuries, regardless of whether or not surgery has been performed. However, once a patient has surgery, it becomes imperative that the surgical repairs be adequately protected while reaching rehab goals.

However, Dr. Bailie understands that while participating in proper rehab is critical, accessibility has become limited, as a result of many insurance carrier restrictions on annual visits allowed and the co-pay cost of each visit. He has collaborated with Todd Ellenbecker, DPT on many occasions for research and they have created a video series to allow patients to correctly perform basic shoulder rehabilitation at home using the AZISKS SHOULDER THERAPY KIT. Below you will find the videos, also available on the AZISKS YOUTUBE channel.

There are three essential parts to successful outcomes in Orthopedic Surgery of the knee and shoulder and recovery from sports injuries.

PHYSICIAN

Accurate diagnosis is extremely necessary in order to provide effective treatment and appropriate treatment recommendations must be made in a timely fashion. If surgery is necessary, the surgeon’s skills must be meticulous, as surgery is as much an art form as it is intellectual. Studies have demonstrated that becoming an expert requires intense practice for no less than 10 years or 10,000 hours.

PATIENT

Patients need to have a basic understanding of their problem and the treatment plan. The surgeon should provide information, supported by scientific literature, which allows the patient reasonable expectations for a successful outcome. In order to facilitate the best possible results, the patient must actively participate in their own care by following the treatment plan from start to finish.

PHYSICAL THERAPIST (PT)

Physical therapy cannot be overlooked as it can often mean the difference between an excellent outcome and a less than satisfactory one. This is especially true after any reconstructive procedure, and particularly those of the shoulders.

Insurance carriers have drastically cut the number of annual supervised physical therapy visits, regardless of the number or scope of problems a patient may have. As a result, it has become increasingly more important for physical therapy to be as efficient as possible.

Dr. Bailie has carefully handpicked the physical therapy clinics he prefers across the valley and state based upon his patients’ comments, experiences and all observed outcomes. He believes the repetition of a team approach allows for patients to achieve their goals more quickly and safely. As Dr. Bailie is not a physical therapist, he cannot and should not have to tell a PT how to do the appropriate therapy. By using the same trusted clinics repeatedly, he has been able to become acutely aware of the therapists who possess both the knowledge and skills necessary to successfully treat his patients.

Dr. Bailie has published many of his protocols, jointly developed with Todd Ellenbecker, DPT of Physiotherapy Associates, in a variety of professional journals and textbooks. Some of these may be found below in PDF format, available for download, and others are listed in our OUTCOMES-RESEARCH Tab/PUBLICATIONS for your reference.

ATTENTION PHYSICAL THERAPISTS

In order to properly rehab a shoulder after an arthroscopic RCR, you must understand the current thinking of shoulder biology, biomechanics, repair techniques and timing of specific exercises during rehab of the rotator cuff. This article provides information on rationale, rehab summary and guidelines. The knowledge and manual skills of the therapist (i.e. the PT’s skill at the “art” of therapy) will impact the outcome. You must respect the limits and skill of those you have attend to these patients. Introducing the wrong exercises at the wrong time may result in detrimental outcomes. It only takes one mishap during a critical phase to influence a poor outcome.

SHOULDER REHABILITATION VIDEO SERIES AzISKS SHOULDER REHAB KIT: $49.95 plus S/H available by emailing info@azisks.com. May also arrange to pick up at an AzISKS office and void S/H charges.

This video series is designed to assist patients with pre-surgical rehabilitation of the shoulder and allow them to safely continue a home-based program after completion of formal therapy. While effective for many disorders, it may not be suitable for all patients and may not substitute for the need of formal physical therapy under direct supervision by a qualified shoulder therapist.

DISCLAIMER: The Arizona Institute for Sports Knees and Shoulders, LLC (AzISKS) Shoulder Rehab Video Series is property of AzISKS. It was developed in coordination with AZISKS president and shoulder surgeon David S Bailie, MD, and physical therapist Todd Ellenbecker MS. PT, SCS, CSCS, Past Chairman of the USTA Sports Science Committee. They have collaborated on numerous shoulder publications and book chapters regarding outcomes in shoulder surgery and physical therapy protocols. in addition to an academic partnership, they partner with their patients to create a clinical program which actively involves their patients. This team approach has led to superb outcomes across all types of shoulder injuries/diseases with and without surgical care. This video series was created in order to help patients with their home exercise program and minimize the costs and time associated with formal rehab. The exercises depicted are their recommended techniques and may not be suitable for all patients. For patients being treated by other providers, it is important NOT TO PERFORM any of these exercises without first discussing them with your surgeon or therapist. This is especially true if you have recently had surgery. Always check with your healthcare provider before starting any exercise program, including this one. If you are a patient of Dr. Bailie, and recently had surgery, you will have been instructed on which exercises to perform or not perform. This video series will help reinforce proper techniques. If you have not had surgery, this video series will be help you understand and perform home exercises safely. Before you bring this or any exercise program, always ask your treating physician and/or physical therapist if you have any questions.

The series is designed to progress through a graduated program. Phase 1 involves range of motion exercises for post-op patients and those with a stiff shoulder. Phase 2 introduces sfae and proper strengthening exercises to address all of the muscles that are important in shoulder function. Phase 3 is advanced and challenges the shoulder muscles further in order to return to sports and higher levels of activity.

All images and videos are property of Arizona Institute for Sports Knees and Shoulders, LLC, (AzISKS, LLC) and may not be reproduced without written permission from David S Bailie MD. Exercises shown should not be performed without consulting with your physician.

PHASE 1- RANGE OF MOTION

These exercises are indicated for patients who have range of motion loss or tightness in their shoulder limiting motion. It is important to do these exercises slowly and several times per day to ensure that your shoulder gains the necessary range of motion needed for functional activities. Each exercise works a specific range of motion. Doing 5-10 repetitions of each exercises several times per day will provide a training stimulus to increase your shoulder range of motion. Holding the end range of motion to impart a “stretch” is of utmost importance. Holding this end range position for 5 to as much as 15 seconds will provide a proper stretch to help improve your motion. Pain at the end range of motion can be encountered, and it is important to gain clarification as to whether a mild or moderate level of pain is acceptable for your condition from your doctor or therapist. With all exercises if significant pain is encountered consult your doctor or therapist for more information and evaluation.

1-1 OVERHEAD PULLEY- FACING WALL (EASIER)

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1-2 OVERHEAD PULLEY BACK TO WALL (ADVANCED)

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1-3 SUPINE FORWARD FLEXION

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1-4 EXTERNAL ROTATION AT 45 ABDUCTION

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1-5 EXTERNAL ROTATION AT 90 ABDUCTION

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1-6 INTERNAL ROTATION UP THE BACK WITH STICK

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1-7 X-ARM ADDUCTION SKETCH

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1-8 SLEEPER STRETCH

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PHASE II: STRENGTHENING

The exercises listed in Phase II and III are recommended to improve strength and local muscular endurance of the shoulder and scapular (shoulder blade) region. It is important to perform the exercises slowly and with control using the proper resistance. The resistance tubing included in your kit has multiple resistance levels. It is important to use the resistance level and elongation level that allows you to do multiple sets of 15 repetitions of the exercise with proper form. A common error by many patients is to use too much resistance, thereby jeopardizing technique and overloading the shoulder structures. YOU SHOULD NOT HAVE PAIN DURING THE PERFORMANCE OF THESE EXERCISES. If any exercise causes pain, discontinue that exercise and consult your doctor or therapist. You should feel fatigue in the shoulder and upper back muscles during proper performance of these exercises. Perform these strengthening exercises one time per day, allowing the exercising muscles time to recover unless otherwise instructed by your therapist or doctor.

2-1 EXTERNAL ROTATION STEP-OUTS

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2-2 INTERNAL ROTATION STEP-OUTS

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2-3 STANDING EXTERNAL ROTATION

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2-4 STANDING INTERNAL ROTATION

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2-5 STANDING EXTENSION

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2-6 SIDELYING EXTERNAL ROTATION

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2-7 SIDELYING SHOULDER FLEXION

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2-8 EXTERNAL ROTATION WITH SCAPULAR RETRACTION

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PHASE III: ADVANCED STRENGTHENING

The exercises listed in Phase II and III are recommended to improve strength and local muscular endurance of the shoulder and scapular (shoulder blade) region. It is important to perform the exercises slowly and with control using the proper resistance. The resistance tubing included in your kit has multiple resistance levels. It is important to use the resistance level and elongation level that allows you to do multiple sets of 15 repetitions of the exercise with proper form. A common error by many patients is to use too much resistance, thereby jeopardizing technique and overloading the shoulder structures. YOU SHOULD NOT HAVE PAIN DURING THE PERFORMANCE OF THESE EXERCISES. If any exercise causes pain, discontinue that exercise and consult your doctor or therapist. You should feel fatigue in the shoulder and upper back muscles during proper performance of these exercises. Perform these strengthening exercises one time per day, allowing the exercising muscles time to recover unless otherwise instructed by your therapist or doctor.

MISSION STATEMENTOur mission is to provide you with the highest quality, cost-effective Orthopedic Care available anywhere.

For any orthopedic related or general questions, you may reach Dr. Bailie personally at dsb@azisks.com. He cannot provide you with a specific diagnosis or recommend treatment without an in office consultation.